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NPI Code Detail

MEDICARE: DILLETA ANDREE SHACKELFORD APRN

MEDICARE: DILLETA ANDREE SHACKELFORD APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LX0106XOccupational Health Nurse PractitionerRN080625GA

General Provider Information

NPI Number : 1811209208
Entity Type Code : Individual
Provider Name (Legal Business Name) : DILLETA ANDREE SHACKELFORD APRN
Provider Business Mailing Address
First Line : 520 GRIFFIN AVE
Second Line :
City : VALDOSTA
State : GA
Zip : 31601-6331
Country : US
Telephone Number : 229-249-6302
Fax Number : 229-249-4009
Provider Business Practice Location Address
First Line : 520 GRIFFIN AVE
Second Line :
City : VALDOSTA
State : GA
Zip : 31601-6331
Country : US
Telephone Number : 229-249-6302
Fax Number : 229-249-4009
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2010
Last Update Date : 07/14/2010

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